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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings 9e of <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. <br /> Attach cgmplQ*site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County <br /> include but not limited to: vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 0-1 IDD- 0I- L(va <br /> _ lff I <br /> APPLICANT INFORMATION- Please print all information. II Reviewed by All <br /> DateO <br /> � <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Wa <br /> Property Owner Property Location <br /> S eiJ C C? �oSe j/Jj/ Govt.Lot 1/4 1/4,S,-y T V6 ,N,R/S" E(od <br /> Prop rty Owner's Mailing Address Lot# Block# Subd.Name er99M# <br /> 9.;2 Z> a CA~29/e,U L e -3 — s /r� 144c= <br /> City // SbAe Zip Code Phone Number ❑ City ❑ yillage 2� Town Nearest Road <br /> AN 15,5107 9 (6S/ <br /> New Construction Use: MResidential/Number of bedrooms Addition to existing building ` <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow ysU gpd Recommended design loading rate - _bed,gpd/ft2 e 6 trench,gpd/ft2 <br /> Absorption area required 1'049 bed,ft2 �O ttrench,ft2 Maximum design loading rate s-'5.'bed,gpd$� � trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 91�� n(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> // �- n <br /> Parent material a�.4C.'��4� Q�� � Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system (s U tKS ❑ U XS ❑ U HS ❑ U S ❑ U ❑ S ,K U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> g in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots ged , Trench <br /> o-y J.S��P /S s �S cd • 7 - <br /> Ground 3 > -;y/f lL �S /l� /!lr✓r�" c-- . �� <br /> �elev. <br /> Depth to <br /> limiting <br /> factor <br /> ;>22 in. <br /> Remarks: <br /> Boring# <br /> Ground <br /> elev <br /> Depth to <br /> limiting <br /> factor <br /> '�P7Xfn. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 7.zs G <br /> Address c Date CST Number <br /> Bs t 5_/ S/st C.It.) �•J-� 5'y�7..Z l/-.OZY`98' p3S8� <br />